Management of the menopause

Missed symptoms of menopause

OBJECTIVE

This review examines the available data on the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) for treating the commonly missed climacteric symptoms of menopause.

DISCUSSION

Although some women may pass through the menopausal transition phase with few or no symptoms, the majority experience one or more symptoms serious enough to be disruptive to their lives. The most common are vasomotor symptoms (VMS; hot flushes and night sweats), but they are not the only climacteric symptoms that can negatively affect quality of life. The 'missed symptoms' of menopause -- symptoms with high prevalence and an impact on quality of life that nonetheless receive less attention than do VMS -- include mood changes, sleep disturbances and somatic complaints. These symptoms are reported by approximately half of menopausal women, with numbers varying by region and ethnic background. As with VMS, the effects of declining oestrogen levels on serotonin/noradrenaline pathways could play a role in their development.

CONCLUSIONS

Results from pilot studies of several SSRIs and SNRIs suggest that they may improve menopausal mood and sleep symptoms, but few studies have demonstrated significant improvement compared with placebo. One SNRI (venlafaxine) improved menopausal mood symptoms and two SSRIs (citalopram and paroxetine) improved sleep, each in a single placebo-controlled trial of women with VMS. Additional placebo-controlled trials are needed to determine whether SSRIs or SNRIs are effective treatment options for women who cannot or choose not to use hormone therapy.

Mental health among perimenopausal women attending a menopause clinic: possible association with premenstrual syndrome?

BACKGROUND

Psychiatric symptoms are frequent in the perimenopause. They are similar to symptoms observed at different stages of a woman's life cycle, suggesting that there may be an association between mental disturbances of the perimenopause and those observed during premenstrual and postnatal periods.

METHODS

This study aimed to determine the reliability of using a modified version of the Steiner premenstrual tension self-rating scale (PMTS) questionnaire for assessing retrospectively the presence of premenstrual complaints and to evaluate the association between previous premenstrual complaints and psychiatric symptoms at the time of the menopause. Forty-one perimenopausal women were selected to establish the reliability of the questionnaire to assess premenstrual symptoms retrospectively (4-8-week interval between measures); agreement between measurements was assessed using the kappa statistic. Ninety-six women were later recruited from a gynecological menopause outpatient clinic to study the association between premenstrual complaints and the presence of psychiatric symptoms at the time of the menopause (as measured by another self-reporting questionnaire, the SRQ-20); SRQ-20 total scores greater than 7 were considered to be indicative of psychiatric morbidity.

RESULTS

All 36 PMTS items showed moderate to very good test-retest reliability (0.44 < kappa < 1.0). There was a significant correlation between total PMTS and SRQ-20 scores (Spearman correlation coefficient 0.75, p < 0.001), correlation coefficient and SRQ-20 total scores greater than 7 were found in 47.9% of patients.

CONCLUSIONS

Premenstrual symptoms can be reliably measured in perimenopausal women. Women who report having experienced premenstrual dysphoria are more likely to present with psychiatric symptoms at the time of the menopause.